Valve repair redo?

[delcar]

I just had my 2yr echo. My valve is leaking again, very surprised I've been feeling great. Dr. says my heart has enlarged to 6.0, from last years echo of 4.8. I've sent the results to U.C.L.A, waiting to hear back from them. My question is can the valve be repaired again?

 

[Daren]

Howdy Delcar, I was in the same situation a few months ago. Had a repair done the first time around that went South on me. I asked the Surgeon about another repair but in my case the valve was too chewed up. He could only give me 50/50 odds on the 2nd repair lasting for a while . Your case may be different, in that the valve may be in better shape. UCLA has some great Doctors and they should be able to give you more info than I can. Hope this helps.... Daren

 

[Greg a]

I would imagine that the answer is that we are all different and you "never say never" I am sorry you are facing this but thank God for follow up visits

 

[traveler]

Good luck and let us know what the doctor says

 

[delcar]

Howdy Delcar, I was in the same situation a few months ago. Had a repair done the first time around that went South on me. I asked the Surgeon about another repair but in my case the valve was too chewed up. He could only give me 50/50 odds on the 2nd repair lasting for a while . Your case may be different, in that the valve may be in better shape. UCLA has some great Doctors and they should be able to give you more info than I can. Hope this helps.... Daren

Thanks for the reply. I'm worried about that, they said the first repair was difficult.

 

[delcar]

Thanks for the reply Greg Yes without that follow up I would have no idea. My doctor here in town wants to wait 3 months, see what it looks like. I'm thinking I'd rather get it taken care of soon, before theres anymore damage. I should hear from UCLA this week sometime.

 

[ALCapshaw2]

Do you have copies of ALL of your Echocardiogram Reports?
If not, I highly recommend that you obtain them from the records department of whatever facility performed them.

It's not clear what measurement you are refering to.
The numbers (4.8, 6.0) are in the range that would correspond to an Aortic Aneurysm.
Is that the case? If so, it's time to be interviewing Aorta Surgeons.
UCLA is a good place to go for such surgery.

'AL Capshaw'

 

[delcar]

Hi AL Yes I have sent all copies to Dr. Shemin at UCLA. The numbers I gave were the enlargement of my left chamber. At least I think thats what the doctor was referring to, like I said I was in shock at the time. The mitral valve is the one leaking. I had robotic mitral valve repair done in August 2008 at UCLA. The forum was a great deal of help preparing me to ask the right questions. And informing me of what to expect at the time.

 

[ejc61]

Hello delcar,

I think that upper left chamber is the atrium. That would get bigger with a MV problem. Mine was pushing 6+ when surgery was recommended. It think my last Echo and TEE put it at about a 4.8. I don't have my notes here. I am concerned about how may repairs can be done also. My surgeon said it was the most common type repair but we can never know. I would have a long talk with the surgeon. If they told me 50/50 on the second repair, I would think about replacement. Luckily, they can do robotic and mini replacements.
I would ask about getting a TEE done to get a better picture than the echo. They will most likely do that anyway if surgery is being considered.

 

[delcar]

Yes I agree with your thoughts on a second repair, if 50/50 is it. What is a mini replacement. I'm thinking that a Tee will be the next step, when I hear from Dr. Shemin.

 

[ejc61]

Hello delcar,

A good site to check out is the Cleveland Clinic. Pull up mitral valve repair and replacement. It doesn't mean you have to go there, clearly, but it is a great source of information. What I meant to say is a mini-thoracotomy. It's minimally invasive in that it goes through the right rib. Sort of the same principle as robotic except without the robot. The surgeon does it manually. The technique is about 10-12 years old. This was the technique I was going to choose until I found out that I was a good candidate for robotic. The mini-thoracotomy technique can be used for repair or replacement the last I read. It is not a sternotomy. Of course, a surgeon would know better. I should have been more clear. I can understand the stress you must be feeling. My repair was the common one according to the surgeon. I always have it in my mind that I will need additional work since my regurg went from severe to mild to moderate after surgery. The one thing I know is that it won't be as scary as last time.

 

[Herburban1]

Sorry to hear that...My 2 year echo is Thursday...fingers crossed.

 

[Lynlw]

Yes I agree with your thoughts on a second repair, if 50/50 is it. What is a mini replacement. I'm thinking that a Tee will be the next step, when I hear from Dr. Shemin.

Do you know why or where the valve is leaking? I THINK wether it can be succesfully repaired again depends on what exactly is wrong with it now.

Did Dr. Shemin do your first repair? If so I probably would get second opinions from other surgeons, if only to hear what their suggestions are.

 

[ryen0]

I just had my 2yr echo. My valve is leaking again, very surprised I've been feeling great. Dr. says my heart has enlarged to 6.0, from last years echo of 4.8. I've sent the results to U.C.L.A, waiting to hear back from them. My question is can the valve be repaired again?

Hi delcar,

Do you know exactly what caused your valve to leak in the first place? From what i've read it would seem that diseased valves and tissue usually have trouble being or staying repaired. However, if it is just a structural problem (something came loose..) then i would think they could repair it again. I guess it all depends on your particular situation. If you are considering getting it repaired again you might consider going somewhere that has a tremendous success rate with repairing the valve vs. replacing it. Good luck to you

Edit: I see Lyn beat me to it by seconds

 

[Bear72]

Hello delcar,

A good site to check out is the Cleveland Clinic. Pull up mitral valve repair and replacement. It doesn't mean you have to go there, clearly, but it is a great source of information. What I meant to say is a mini-thoracotomy. It's minimally invasive in that it goes through the right rib. Sort of the same principle as robotic except without the robot. The surgeon does it manually. The technique is about 10-12 years old. This was the technique I was going to choose until I found out that I was a good candidate for robotic. The mini-thoracotomy technique can be used for repair or replacement the last I read. It is not a sternotomy. Of course, a surgeon would know better. I should have been more clear. I can understand the stress you must be feeling. My repair was the common one according to the surgeon. I always have it in my mind that I will need additional work since my regurg went from severe to mild to moderate after surgery. The one thing I know is that it won't be as scary as last time.

From what the Cleveland Clinic has told me, they will only do a sternotomy to re-repair/replace a mitral valve that was already repaired using the DaVinci system. It has something to do with already collapsing the lung once before (or so they say). I'm assuming with the thoracotomy, they also have to push the lung aside. BUT, I'm not sure how your surgery was performed previously.

I am very curious if you decide to go with the same surgeon. Some doctors say that you should use the same guy because he knows his work and may be able to save the valve. I personally would get a few opinions. First on the list is a TEE without a doubt. I can feel for you because I'm going through the exact same thing. The cardiologists say it can be re-repaired because one of the gortex chordae snapped away while the rest of the valve looks fine. The only reason they could see the leak was from a TEE because there was no enlargement, nothing showed on a regular echo, but only a murmur was the indicator. But to hear that you need another surgery is absolute BS after being told "you're the ideal candidate" for a repair.

 

[delcar]

So they are telling you that they have to split your chest to do a re-repair? I was hoping that I could avoid that. I had the first repair done with the DaVinci system. I was hoping to just do this once!

 

[ejc61]

I guess I need to contact my surgeon.

 

[ejc61]

My surgeon's office said they have the training to have redo's (inital - robotic) done robotic or minimally invasive. Of course, all the factors will have to be taken into account. It really does go down to the surgeon's comfort level.

 

[Bear72]

My surgeon's office said they have the training to have redo's (inital - robotic) done robotic or minimally invasive. Of course, all the factors will have to be taken into account. It really does go down to the surgeon's comfort level.

That's very interesting to hear. Perhaps I will contact Dr. Murphy's office to see what they say. I spoke to my surgeon on the phone a few weeks ago and he advised the re-repair would have to be done with a sternotomy. It may be a minimally invasive one with a smaller incision, but he assured me that he won't perform a re-do, that was originally done robotically with the DaVinci system again. It was my understanding that it had to do with the lung being collapsed during the original repair. Who knows...it just gets me that I just had this done a year and a half ago at the Cleveland Clinic. Such cr@p.

 

[ejc61]

Hey Bear,

While on an on-line chat with Cleveland Clinic, the nurse on the other end said that Dr. Gillinov will be having a webchat event on 3/14/11 discussing in some manner robotic valve surgery. She said that it may be a good opportunity to ask questions. I'm not exactly sure how that webchat works. As far as the collapsed lung thing, I would have thought that the lung is collapsed during open sternotomy as well.
I guess he meant a mini-thoracotomy thru the rib thing technique? That would still be better.